Diagnostic Cytopathology最新文献

{"title":"Cumulative Cytological Assessment of Repeated Non-Diagnostic Thyroid Fine Needle Aspirations: A Novel Approach to Reduce Diagnostic Uncertainty.","authors":"Shiri Damti Geva, Wafaa Emiel Haj, Yokhanan Spivak, Yara Assaf, Mussa Abed Al Aziz, Daniella Itzhak, Alejandro Livoff, Ohad Ronen","doi":"10.1002/dc.70139","DOIUrl":"https://doi.org/10.1002/dc.70139","url":null,"abstract":"<p><strong>Purpose: </strong>Fine needle aspiration (FNA) is the primary diagnostic tool for evaluating thyroid nodules. However, 10%-21% of FNAs yield non-diagnostic (ND) results (Bethesda category I). Repeated ND findings occur in 25%-67.5% of cases, creating diagnostic uncertainty and increased healthcare costs. Our aim was to evaluate whether cumulative analysis of repeated ND cytology samples enables reclassification into a diagnostic Bethesda category.</p><p><strong>Methods: </strong>This retrospective observational study (2013-2024) included patients with ≥ 2 ND FNA results from the same thyroid nodule. Two blinded cytopathologists performed cumulative assessment of cellular material from consecutive ND samples to determine if reclassification into diagnostic Bethesda categories was feasible.</p><p><strong>Results: </strong>Among 1861 FNA procedures, 29 patients (1.56%) had ≥ 2 ND results. Cumulative assessment enabled reclassification in 3/29 patients (10.3%), into Bethesda category II (benign).</p><p><strong>Findings: </strong>In selected cases, cumulative cytological assessment of multiple ND FNAs may provide sufficient diagnostic material to allow reclassification. This novel cost-effective approach may help reduce diagnostic uncertainty and unnecessary procedures, and improve patient care.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fine Needle Aspiration of Hyalinizing Clear Cell Carcinoma. Report of a New Case and Review of the Literature.","authors":"Katarzyna Cedor, Maria Lesnik, Jerzy Klijanienko","doi":"10.1002/dc.70138","DOIUrl":"https://doi.org/10.1002/dc.70138","url":null,"abstract":"<p><p>Hyalinizing clear cell carcinoma (HCCC) is a rare salivary gland malignancy with variable malignant potential. Only 8 cases studied by fine needle aspiration have been reported in the literature. We have observed axillary metastasis in a patient with oropharyngeal HCCC. Smears were cellular and composed of middle-sized, oval cells with round and ovoid hyperchromatic nuclei without atypia. Some mitotic figures and intranuclear cytoplasmic inclusions were present. Most of the cells exhibited dense and occasionally clarified cytoplasm. Tumor cells were mostly arranged in loose clusters rich in rosette-like formations and naked nuclei. FISH revealed EWSR1 translocation. Comparing our case with 8 previously reported cases, it is evident that it is possible to make the diagnosis of HCCC on smears, especially when EWSR1 translocation is present.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Anaplastic Transformation of Tall Cell Papillary Thyroid Carcinoma in Metastatic Lymph Nodes With Extremely Rare Co-Occurrence of BRAF p.V600E and KRAS p.G12R Mutations: A Unique Case.","authors":"Alicia Ming Xi Chia, Lih Khuang Go, Hui Lin Teo, Jereme Yi Jin Gan, Manish Mahadeorao Bundele","doi":"10.1002/dc.70141","DOIUrl":"https://doi.org/10.1002/dc.70141","url":null,"abstract":"<p><p>We report a case of a 57-year-old male with anaplastic transformation of papillary thyroid carcinoma (PTC) in metastatic lymph nodes. This case presents as a pitfall due to squamous differentiation in anaplastic thyroid carcinoma, which was initially misinterpreted as metastatic squamous cell carcinoma on fine needle aspiration (FNA) of the lymph node in the neck. Subsequent surgical resection reveals a unique rare occurrence of isolated anaplastic transformation of tall cell PTC in the metastatic lymph nodes, associated with the extremely rare co-occurrence of BRAF p.V600E and KRAS p.G12R mutations.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytomorphologic Patterns of Tubercular Lymphadenitis and Its Correlation With ZN Stain and CBNAAT: A Six-Year Study in a Tertiary Medical College of North India.","authors":"Sudha Sharma, Anish Chandran, Vinay Kumar Kaushik, Rajni Kaushik","doi":"10.1002/dc.70137","DOIUrl":"https://doi.org/10.1002/dc.70137","url":null,"abstract":"<p><strong>Background: </strong>India has the world's highest burden of tuberculosis (TB). Tubercular lymphadenitis accounts for approximately 40% of extrapulmonary cases. The incidence, demographic profile, and cytologic spectrum vary in different regions. We analyzed the cytologic spectrum and diagnostic yield of Fine Needle Aspiration Cytology (FNAC), Ziehl-Neelsen (ZN) staining, and Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) in a tertiary medical college of North India.</p><p><strong>Materials and methods: </strong>A 6-year retrospective study (2018-2023) was performed, where 201 TB cases out of 854 lymph node FNACs were analyzed. Cases were categorized into four patterns: Pattern A (Necrosis with granuloma), Pattern B (Granuloma only), Pattern C (Necrosis only), and Pattern D (Acute suppuration). Findings were correlated with ZN grading and CBNAAT results.</p><p><strong>Results: </strong>The incidence of tubercular lymphadenitis was 23.5%. 21-30 years was the most common age group involved (37.8%), with a female predilection (69.6%). Cervical nodes were the primary site of involvement (72.1%). Pattern A was the most common (75%). Overall, ZN positivity was 45.3% and CBNAAT was 62.2%. CBNAAT sensitivity was highest in Pattern D (100%) and Pattern B (85%). ZN staining showed the highest sensitivity in Pattern B (60%), though with low bacterial loads (1+). While 38.8% of cases were positive for both ZN and CBNAAT, 23% were detected by CBNAAT alone.</p><p><strong>Conclusion: </strong>FNAC is an effective first-line tool, but morphological patterns may vary. ZN and CBNAAT are complementary; CBNAAT significantly increases sensitivity, particularly in suppurative or paucibacillary cases. A multimodal approach ensures higher diagnostic accuracy and facilitates early initiation of Antitubercular Treatment (ATT).</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytological Diagnosis of Metastatic Dedifferentiated Chondrosarcoma in Pleural Effusion: A Rare Case Report.","authors":"Damleen Kaur, Ravikiran N Pawar, Sankalp Sancheti, Nilay Nishith, Pranab Dey","doi":"10.1002/dc.70135","DOIUrl":"https://doi.org/10.1002/dc.70135","url":null,"abstract":"<p><p>Dedifferentiated chondrosarcoma is a rare, high-grade malignant bone tumor distinguished by its highly aggressive clinical course. This primary bone malignancy is characterized by the coexistence of a low-grade cartilaginous component and an abrupt transition to a high-grade non-cartilaginous sarcoma. Although pulmonary metastases are common, pleural involvement presenting as malignant effusion is exceedingly rare and poorly documented in cytology literature. We report a case of a 49-year-old man with previously diagnosed pelvic dedifferentiated chondrosarcoma who presented with massive pleural effusion and multiple pulmonary nodules. Cytologic examination of the pleural fluid revealed scattered large pleomorphic malignant cells with moderate cytoplasm, irregular nuclear membranes, and prominent nucleoli, admixed with reactive mesothelial cells. Immunocytochemistry on cell block sections showed tumor cells positive for vimentin and negative for cytokeratin (AE1/AE3), calretinin, S-100, WT1, and IDH1 (R132H). Correlation with the prior histopathologic findings of the iliac bone lesion confirmed metastatic dedifferentiated chondrosarcoma involving the pleural cavity. To the best of our knowledge, this is the first reported case of cytology of DDCS in effusion cytology. This case highlights the exceptional metastatic potential of DDCS and underscores the critical role of cytology, supported by clinicoradiologic and immunocytochemical correlation, in diagnosing rare metastatic presentations in serous effusions.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal Fluid Cytology of Mesonephric-Like Adenocarcinoma of the Fallopian Tube: A Case Reflecting Diverse Histologic Architecture.","authors":"Shinji Toyoda, Kohei Morita, Toshiyuki Sado","doi":"10.1002/dc.70134","DOIUrl":"https://doi.org/10.1002/dc.70134","url":null,"abstract":"<p><p>Mesonephric-like adenocarcinoma (MLA) is a rare gynecologic cancer, and primary involvement in the fallopian tube is extremely uncommon. We report a case of fallopian tube MLA with detailed peritoneal fluid cytology findings and a comparison of conventional smear and liquid-based cytology preparations. A 57-year-old woman presented with pelvic pain and ascites. Histopathologic examination confirmed stage IIIC MLA of the fallopian tube. Peritoneal fluid cytology, using both conventional smears and liquid-based cytology, showed moderate to high cellularity, with three-dimensional clusters exhibiting tubular, cribriform, papillary, and solid architectural patterns. The tumor cells were relatively uniform, and occasional cribriform structures were observed. Histologically, the tumor exhibited predominantly tubular and solid growth patterns, with focal areas resembling mesonephric tubules. The tumor cells showed focal elongated nuclei with overlapping nuclear grooves, resembling papillary thyroid carcinoma-like nuclear features characteristic of MLA. Immunohistochemically, the tumor cells demonstrated diffuse nuclear positivity for GATA3 and TTF-1, with widespread PAX8 expression. This case demonstrates that peritoneal fluid cytology can closely reflect the histologic heterogeneity of MLA and emphasizes the importance of correlating cytologic architectural features with immunohistochemical findings, particularly in this extremely rare entity.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the Ion Robot in the Diagnosis of Pulmonary Nodules: Fine Needle Aspiration Versus Cryobiopsy.","authors":"Suzanne M Selvaggi","doi":"10.1002/dc.70136","DOIUrl":"https://doi.org/10.1002/dc.70136","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted bronchoscopy platforms provide an innovative approach to the sampling of pulmonary nodules. As compared to other technologies, fiber-optic shape-sensing instrumentation allows for a more precise, accurate location and sampling of the target lesion with fewer complications. As FNA is a mainstay in the evaluation of pulmonary nodules, this study compares FNA diagnostic yield to cryobiopsy using the Ion robotic system.</p><p><strong>Methods: </strong>From January 1, 2025 through June 30, 2025, the Cytopathology laboratory processed 87 FNAs with concurrent cryobiopsies from pulmonary nodules and form the basis of this study.</p><p><strong>Results: </strong>Of the 87 FNAs, 45 (52%) were positive/suspicious for malignancy, 4 (5%) were positive for a neoplasm, 5 (6%) were atypical, 13 (15%) were negative and 20 (23%) were nondiagnostic. Cryobiopsies were concordant in 59 (68%) cases and discordant in 28 (32%) cases. Of the 28 discordant cases, 3 had neoplastic cells on FNA of which 2 were nondiagnostic and 1 showed atypical cells on cryobiopsy. Of the 5 FNAs with atypical cells, 5 were malignant on cryobiopsy. Of the 20 nondiagnostic FNAs, 13 were malignant and 7 were negative on cryobiopsy. FNA diagnostic yield was 71%, sensitivity 66%, and specificity 100%. The cryobiopsy diagnostic yield was 96%, sensitivity 94%, and specificity 100%.</p><p><strong>Conclusion: </strong>At our institution, use of the Ion robotic system for the evaluation of pulmonary nodules has led to increased diagnostic yields over standard FNA with ROSE. This technology provides an additional modality for the sampling of pulmonary nodules; in particular, those located peripherally.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Cytological Features of Thyroid Bed Fine-Needle Aspirations.","authors":"Sajjad Mohammedjoead, Aurora Zaccagnino, Cosimo Custoza, Vijaya Reddy, Paolo Gattuso","doi":"10.1002/dc.70133","DOIUrl":"https://doi.org/10.1002/dc.70133","url":null,"abstract":"<p><strong>Background: </strong>Patients who undergo total thyroidectomy for primary malignant neoplasms are routinely monitored for recurrence in the thyroid bed. Fine-needle aspiration (FNA) cytology is often performed to evaluate suspicious thyroid bed lesions, but its diagnostic reliability and correlation with thyroglobulin (Tg) levels remain incompletely characterized.</p><p><strong>Methods: </strong>A retrospective review was performed of thyroid bed FNAs diagnosed between 2008 and 2023 at Rush University Medical Center. Clinical data, cytologic findings, surgical pathology follow-up, and serum Tg levels were analyzed. Cytologic diagnoses were classified using the Bethesda System for Reporting Thyroid Cytopathology (TBS).</p><p><strong>Results: </strong>Forty-one thyroid bed FNAs from 38 patients (32 females, six males; age 20-84 years, mean 52) were identified. The original thyroidectomy specimens included 28 papillary thyroid carcinoma (PTC), two follicular carcinoma (FC), two medullary carcinomas (MC), two carcinoma NOS, one poorly differentiated carcinoma, and three multinodular goiters. Cytologic categories included TBS VI (10), V (4), IV (2), III (2), II (12), and I (11; 27% nondiagnostic). Sixteen patients underwent subsequent surgical biopsy/resection; 12 had TBS III or higher cytology, all of which were malignant on histology (100% concordance). Of seven patients with available Tg levels in this group, 3 were normal (< 1 ng/mL) and four were increased (> 1 ng/mL). Among four patients with nondiagnostic cytology, one showed malignancy and elevated Tg.</p><p><strong>Conclusion: </strong>Thyroid bed FNA is a reliable method for detecting recurrent thyroid carcinoma, showing 100% cytohistologic concordance for TBS III and above. Tg is not universally elevated in recurrent tumors (sensitivity 57%), but an increased Tg level in the setting of nondiagnostic FNA warrants further evaluation. The 27% rate of unsatisfactory specimens likely reflects postsurgical scarring, which can clinically mimic recurrence.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Basics to Benchmarks: Evaluating Sample Adequacy, PD-L1 Expression, and Molecular Profiling in Effusion Samples of Lung Adenocarcinoma.","authors":"Harpreet Virk, Claire Michael, Keri Ann Pfeil, Navid Sadri, Omid Savari, Aparna Harbhajanka","doi":"10.1002/dc.70132","DOIUrl":"https://doi.org/10.1002/dc.70132","url":null,"abstract":"<p><strong>Introduction: </strong>Lung adenocarcinoma commonly causes malignant pleural effusion (MPE), a condition with poor prognosis and limited treatment options. Pleural effusion specimens offer a minimally invasive source for diagnosis and molecular testing. This study evaluates cytologic adequacy for molecular analysis, characterizes mutational and PD-L1 profiles, and correlates findings with survival outcomes.</p><p><strong>Methods: </strong>Over 10 years, a review of 2400 MPE identified 94 lung adenocarcinoma cases that underwent next generation sequencing (NGS). Patient demographics, cytological characteristics, molecular features, and survival outcome were integrated for analysis.</p><p><strong>Results: </strong>The mean effusion volume submitted for cytological and molecular testing was 589.8 mL (range 4-2790 mL) and mean tumor cellularity was 40% (range 10%-90%). NGS identified mutations in 86/94 cases (91%). TP53 was the most common alteration (42/94, 44.6%). FDA-approved biomarkers were detected: KRAS (28/94, 29.7%); EGFR (15/94, 15.9%); BRAF (8/94, 8.5%); ALK (3/94, 4.2%), ROS1 (2/94, 2.1%), RET fusions (1/94, 1%); and MET amplification (2/94, 2.1%). Smoking was associated with bloody effusions (p = 0.049), frequent TP53 mutations (p = 0.018), and fewer EGFR mutations (p = 0.012). Patients with effusions as primary presentation was associated with higher mortality (p = 0.002), frequent TTF-1 positivity (p = < 0.001) and frequent BRAF mutations (p = 0.049). TTF-1 positivity was associated with higher PD-L1 scores (p = 0.035). Survival was shorter in male patients (p = 0.045), smokers (p = 0.025), concurrent pericardial effusions (p = 0.027), and with TP53 mutation (p = 0.002).</p><p><strong>Conclusions: </strong>Molecular testing of effusion samples is feasible even at low fluid volumes, provided tumor cellularity is adequate. Prioritizing tumor fraction over volume ensures a higher likelihood of successful molecular analysis. Effusion-based NGS reliably identifies actionable alterations with diagnostic and prognostic relevance. Male patients, smokers, concurrent or primary presentation with MPE, and those with TP53 mutations had poorer outcomes.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Analysis of Cytologic Features: Application to Mucoepidermoid Carcinoma.","authors":"John Effat Bacilious Diks, Saleh Najjar, Saroja D Geetha, S Mohsen Hosseini","doi":"10.1002/dc.70130","DOIUrl":"https://doi.org/10.1002/dc.70130","url":null,"abstract":"<p><strong>Introduction: </strong>Cytologic diagnosis relies on recognition of morphologic features, yet the diagnostic value of individual cytologic features or their combinations is rarely quantified. In this study, we apply a quantitative cytologic feature analysis (QCFA) approach that treats each cytologic feature as a diagnostic test with measurable performance characteristics. Using mucoepidermoid carcinoma (MEC) as a model, we systematically assess and quantify the diagnostic utility of individual and combined cytomorphologic features.</p><p><strong>Methods: </strong>In this retrospective study (2002-2021), 95 salivary gland fine needle aspirates in which MEC was considered in the differential diagnosis were reviewed. Two cytopathologists scored 16 predefined features, including extracellular mucin and three types of vacuolated cells: mucocytes (columnar or cuboidal glandular cells with single mucin-filled vacuoles and eccentric nuclei), epimucocytes (similar to mucocytes but with a dense squamoid cytoplasmic rim), and non-mucinous empty vacuolated cells (containing sharply circumscribed empty vacuoles). Cytologic findings were correlated with follow-up histology, and contingency table analysis was used to calculate sensitivity, specificity, and likelihood ratios.</p><p><strong>Results: </strong>Of 95 cases, 49 (51.6%) were confirmed as MEC on histology. Epimucocytes were the most sensitive feature (0.90), while intermediate cells were the most specific (0.94). Extracellular mucin, mucocytes, and epidermoid cells were also predictive of MEC, whereas non-mucinous empty vacuolated cells were negatively associated with MEC (LR^- = 2.3). The combination of any mucinous feature (epimucocytes, mucocytes, or extracellular mucin) with either intermediate or squamous cells yielded optimal diagnostic performance (specificity 91%, LR⁺ 8.9).</p><p><strong>Conclusions: </strong>QCFA provides objective, quantitative support for established cytologic diagnostic criteria. Using MEC as a model, we introduce a standardized definition for epimucocytes and provide the first quantitative assessment of their diagnostic value. This study demonstrates the feasibility and value of applying rigorous quantitative metrics to individual and combined cytologic features, offering a systematic approach to evaluating morphologic criteria.</p>","PeriodicalId":11349,"journal":{"name":"Diagnostic Cytopathology","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}